Background: In pediatric cancer patients, determination of optimal vancomycin dosage is essential because of high risk of inadequate concentrations and bacterial resistance. The aim of this study was to determine vancomycin pharmacokinetic parameters in this population and propose dosage optimization to achieve optimal concentration.
Methods: We retrospectively reviewed the use of vancomycin in pediatric cancer patients with febrile neutropenia (hematological or solid tumor disease). Vancomycin was administered by continuous infusion, and dosages were adapted according to therapeutic drug monitoring results. Blood cultures were performed before the first dose of antibiotic. Vancomycin pharmacokinetic population parameters were determined using NONMEM software, and dosage simulations were performed according to the target concentration (20-25 mg/L).
Results: One hundred twenty-one patients were included in this study, representing 301 vancomycin concentrations. Blood cultures were positive in 37.5% of patients, and observed pathogens were mainly Staphylococcus spp. (43.8% methicillin resistant). Volume of distribution (95% confidence interval) was 34.7 L (17.3-48.0), and total apparent clearance (CL) (95% confidence interval) was correlated to body weight, tumor disease, and cyclosporine coadministration: CL = θCL × (WT/70) L/h with θCL = 3.49 (3.02-3.96), 4.66 (3.98-5.31), and 4.97 (4.42-5.41) in patients managed for hematological malignancies with or without cyclosporine coadministration and for solid malignancies, respectively. Based on simulation results, vancomycin dosage (milligram per kilogram) should be adapted to each child on the basis of its body weight and cyclosporine coadministration.
Conclusions: Our results highlight the requirement to adapt vancomycin dosage in cancer pediatric population. Simulations have allowed to describe new dosage schedules, and a chart was created for clinicians to adapt vancomycin dosage.
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http://dx.doi.org/10.1097/FTD.0000000000000318 | DOI Listing |
Pathogens
December 2024
Infectious Disease Unit, Bambino Gesù Children's Hospital, IRCCS, 00165 Rome, Italy.
Brain abscesses are invasive infections of the central nervous system with a high level of treatment complexity especially in pediatric patients. Here, we describe a 3-month-old infant with multiple brain abscesses caused by methicillin-susceptible (MSSA). The patient was initially treated with empirical antibiotics (ceftriaxone, metronidazole, vancomycin).
View Article and Find Full Text PDFActa Orthop Belg
September 2024
Reconstruction of the anterior cruciate ligament (ACL) using hamstring autograft presents a greater risk of surgical site infection than other transplants (0.5% to 1.5%).
View Article and Find Full Text PDFBMC Musculoskelet Disord
January 2025
Institute of Statistics, National Yang Ming Chiao Tung University, 1001 University Road, Hsinchu City, 300, Taiwan.
Background: The standard treatment for periprosthetic joint infections (PJI) typically involves a two-stage resection arthroplasty using antibiotic-loaded bone cement (ALBC) spacers. This study hypothesizes that there is no significant correlation between antibiotic levels in blood and synovial fluid and the patient's kidney function, and that the success rates of staged resection arthroplasty are comparable between groups, specifically targeting gram-positive bacterial infections.
Methods: This retrospective review included patients treated from 2017 to 2022 with two-stage arthroplasty using vancomycin-loaded ALBC spacers, selectively targeting gram-positive infections.
Iowa Orthop J
January 2025
Department of Orthopaedic Surgery, Shriners for Children Medical Center, Pasadena, California, USA.
Background: The use of vancomycin powder in spine surgery has been supported in adult populations, however, its efficacy in preventing postoperative surgical site infections in AIS patients is yet to be determined.
Methods: A multi-center review was conducted from June 2010 to February 2019, using ICD and CPT codes to identify AIS patients who underwent primary PSF. The patients were divided into two groups: the vancomycin cohort (receiving local vancomycin powder prior to wound closure) and the non-vancomycin cohort.
Nat Commun
January 2025
Aiiso Yufeng Li Family Department of Chemical and Nano Engineering, University of California San Diego, La Jolla, CA, USA.
Amidst the rising prevalence of respiratory diseases, the importance of effective lung treatment modalities is more critical than ever. However, current drug delivery systems face significant limitations that impede their efficacy and therapeutic outcome. Biohybrid microrobots have shown considerable promise for active in vivo drug delivery, especially for pulmonary applications via intratracheal routes.
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